Download - Pneumothorax class
Dr. Boney Cheriyan ThavalathilEmergency Physician & Intensivist,
Normal pleural space = closed sac in which negative pressure is essential for normal lung expansion during breathing
What’s the normal pleural pressure?
Beginning of inspiration - 5 cm H2O
End of inspiration - 7.5 cm H2O
“Pneumo” – Gas “Thorax” – Chest cavity Occurs when air leaks into the space between the
lungs and chest wall, creating pressure against the lung
SourcesVisceral pleuraRuptured esophagusChest wall defectGas-forming organisms
TraumaticBluntPenetrating
IatrogenicDiagnosticTherapeutic
Spontaneous PrimarySecondary
COPDInfectionNeoplasm
Penetrating Trauma Air entering pleural space directly through chest wall
Blunt Trauma
High Risk Occupations
Transthoracic Needle Aspiration biopsy
Transbronchial Biopsy
Thoracocentesis
Central Venous Catheter Placement
Intercostal Nerve Block
Tracheostomy
Positive Pressure Ventillation
NG tube placement
Penetrating & Non- Penetrating traumaThoracic Spine Fracture Dislocations
Cohesive forces between visceral & parietal pleura disruptedCollapse of the lung
Signs Tachypnea
Tachycardia
Hypotension
Hypoxia
Symptoms
Breathlessness Pleuritic Chest pain
Sudden onset
Tension pneumothorax
Spontaneous pneumothorax
Respiratory
Decreased Breath Sounds
Hyperresonance to percussion
Decreased Tactile Fremitus
Altered Mental Status
Cardiovascular
JVDShift in mediastinum
OtherSubcutaneous
EmphysemaShifted Trachea
Tension pneumothoraxFailure to reexpandPersistent air leakRecurrence
Removal of intrapleural airInfection Reexpansion pulmonary edema
Mediastinal shift
Kinking of SVC & IVC
Decrease in Venous Return to heart
Decrease In C.O
SHOCK & HYPOPERFUSION
ABG
PO2 : decreased
PCO2:Decreased from Hyperventilation
Elevated with respiratory compromise
CXR Inspiratory & expiratory
imagesUnderlying Pul. disease
Harder to detect
CTPSP – Blebs & Bullae Small pneumothoraxAssess the need for
thoracotomy
Absence of “lung sliding” as assessed on the time-motion view
Demonstration of a "lung point" on the time-motion view
Absence of vertical comet-tail artifacts
USGUSG 95% sensitivity95% sensitivity 100% specificity100% specificity
“Seashore sign” “Stratosphere sign”
Normal Abnormal
Normal Abnormal
ABC
History
Examination
Needle aspiration and small chest tube drainage
Goals
Elimination of intrapleural air
Optimization of pleural healing
Prevention of recurrences
Immediate decompression via chest tube or needle thoracostomy
If a tension pneumothorax is present, a “hiss of air” may be heard escaping from the chest cavity
Remove the needle, leave the catheter in place
Rx
Immediate managementWound dressing
Flutter-Type Valve Effect
Rx
Clear and manage the airway
Provide oxygen
Seal an open wound with an occlusive dressing
Rx
Tape down three sides and create a flutter valve
Rx
Chest tubeRemote from the wound
Definite managementSurgical closure of the wound
Rx
OxygenPneumothorax is smaller than 15% Patient is asymptomatic
Needle aspirationPneumothorax is smaller than 15%Symptomatic & hemodynamically stable
Pigtail catheterPneumothorax is greater than 15%
Rx
Tube Thoracostomy
Recurrent PneumothoraxCT to evaluate need for thoracotomy
Thoracoscopy with stapling of blebs
Pleural abrasion & Sclerosing agent (Doxycycline or Talc)
Rx
Aspiration
Tube thoracostomy
Rx